Whopping Medicaid cuts to hit nursing facilities hard

CALIFORNIA – California has managed to gain Obama administration approval to cut the state's Medicaid program funding by $1.4 billion. Providers soon will feel the sting of 10% reimbursement cuts.

Gov. Jerry Brown (D) got his wish granted to make the cuts, which according to the California Department of Health Care Services include 10% provider payment reductions for freestanding nursing and adult sub-acute facilities; a number of outpatient services, including physicians, clinics, optometry, therapy, laboratories, dental, durable medical equipment and pharmacy; and a rate freeze for distinct part/nursing facility-B services.

Spared were a 10% reduction to physician/clinic services for children, home health services or distinct part sub-acute facilities, according to the Department of Health Care Services.

MIDWEST
Fines, forfeitures reprieve
WISCONSIN – “One hand gives and the other takes away” is how some would describe a new law nearing passage at press time. The proposed law would shield nursing homes from the pains of fines and forfeitures but also give the state more power to sue and revoke licenses.

Sponsored by state Rep. Dan Knodl (R), the bill would extend fine payment windows for violations, prevent redundant violations and place time limits (120 days) on state forfeiture actions. While the bill would save the state's nursing homes $1.5 million a year in forfeitures, it also would give the state greater power to suspend or revoke licenses and sue nursing homes that repeatedly violate federal regulations, according to the Milwaukee Journal-Sentinel.

Bill opponents say it needlessly goes easy on a small number of repeat offenders among the state's nursing homes. Advocates claim the current system of fines for the same violations from multiple entities is double jeopardy.

Defection to new union
MICHIGAN – Fed up with the union that served them for decades, workers at a Saginaw nursing home defected to a new one founded two years ago in California.

Luther Manor Nursing Home employees left the Service Employees International Union (SEIU) after years of what they considered substandard union-negotiated contracts and the SEIU's repeated failure to realistically enforce those contracts, Olga Vasquez, a certified nursing aide, told The Saginaw News.

The 80 Saginaw nursing home employees have joined the National Union of Healthcare Workers, founded in 2009 by former leaders of the SEIU-United Healthcare Workers West in California. Thousands of healthcare workers in California have left SEIU and joined NUHW since its founding, according to the newspaper.

The Saginaw nursing home employees are reportedly the first SEIU members outside California to join.

NORTHEAST
Over-medication scrutiny
MAINE – Some nursing homes have been over-medicating their residents, and Maine is among 14 states taking proactive steps to reverse such trends.

Medication monitoring is part of the national Quality Indicator Survey, a two-stage process state surveyors use to review specific nursing home requirements and investigate possible violations of federal rules. Maine has used the survey for two years.

A Food and Drug Administration audit in May 2011 found facilities violate overmedication rules and place residents at risk of death, and that certain drugs were being prescribed for uses not approved by the FDA or not qualified for Medicare patients, according to the Morning-Sentinel online newspaper.

Still, Medicaid spending on antipsychotics seems to be dropping; according to federal figures, such spending fell to $3.7 billion in 2008 from $7.9 billion in 2006.

Other states making notable over-medication efforts include: Illinois, which is considering a law that would restrict the use of psychotropic medications among developmentally disabled in skilled nursing facilities; and California, which launched a public awareness campaign to educate people about laws governing the use of such medications in nursing homes.

Double shooting ‘hits' SNF
MARYLAND – An 80-year-old man and his 74-year-old wife are dead following a double-shooting in a Rockville, MD, nursing home in late October. The incident has been classified a murder-suicide by Montgomery County police.

Police told the Washington Post that Albert Ballard shot and killed his wife, Sandra, a resident at the facility, and then turned the gun on himself. The elder Ballard had visited his wife of 40 years nearly every day since her admittance to the home, according to staff members who knew them.

Police and family friends told the newspaper they suspected Ballard had become despondent in the days leading up to the shooting. One family friend described the shooting as “an act of love,” according to the newspaper. The elder Ballard had been living in the home he and his wife bought in 1967 for $28,000.

A spokesperson for the facility's owner, National Lutheran Communities & Services, said the building is safe and is “taking every precaution necessary to keep it that way.” The individual added that visitors are required to sign in before receiving a badge, which Albert Ballard did regularly.

Transfer form adopted
NEW JERSEY – Continuum of care issues continue to dominate nursing home headlines in the state, which recently implemented a standardized method for tracking transfers to and from hospitals.

New Jersey became the first state to do so as of Oct. 30, according to NJToday.net. The so-called one-page “Universal Transfer Form,” required for all patient transfers from nursing long-term care facilities to hospitals and vice versa, reports such information as vital signs, diagnosis, medications, allergies and respiratory needs.

“Anyone who moves within the healthcare system will have a synopsis of their prognosis, critical care needs and treatment plan,” Health Care Association of New Jersey President Paul Langevin said. The form will be used by hospitals, long-term care facilities, ambulatory care facilities, assisted living facilities and home health agencies.

Goal: All RNs get bachelor's
NEW YORK – A 2010 report by the venerable Institute of Medicine called for 80% of all working nurses to have college degrees by 2020, and the state is on a passionate course to become the first in the country to meet that benchmark. It's well on the way; more than half of all working registered nurses in the state have such degrees.

Studies have shown patients receive better care from college-educated nurses. One recent study showed that death rates decrease 5% in care settings for each 10% increase in the number of nurses with bachelor's degrees, the Albany Times Union recently reported.

Nursing leaders say they plan to renew interest in pushing forward a 2005 proposed bill that would have required new nurses to earn a bachelor's degree within 10 years of receiving their nursing license. But some unions oppose the measure, fearing grandfathered nurses will demand financial assistance for a bachelor's education even though they are currently allowed to practice without one.

The IOM's report, “The Future of Nursing: Leading Change, Advancing Health,” can be viewed at www.iom.edu.

SOUTHEAST
Drugs often lost in transfer
WEST VIRGINIA – Caregivers hope hospitalized patients come into nursing homes leaving a lot of issues behind, but medications should not be among them, long-term care advocates say.

They're giving lawmakers an earful about the problem — a woeful epidemic of critical medications that fall through the cracks during the transfer, the Charleston Gazette reports.

The matter has been tendered to the “Legislative Oversight Commission on Health and Human Resources Accountability” for further study, says the newspaper.

Alleged killer not admitted
FLORIDA – Nursing homes across the country find themselves grappling with how to handle residents with criminal pasts, but Florida now finds itself trying to find one that will care for an alleged killer.

And the man's attorneys are now asking prosecutors to drop the charges.

No nursing home in the state has agreed to admit Steve Bronson, 63, who allegedly admitted last year to the 1979 torture and killing of a St. Cloud woman, according to a report from United Press International.

Bronson, a convicted sex offender who was found incompetent to stand trial on the murder, suffers from untreatable brain damage and is unable to walk or care for himself, reports say. Nursing homes would have no recourse to refuse Bronson as a resident if the charges were dropped, according to UPI.

SOUTHWEST
Tax overpayments returned
NEVADA – Some nursing homes in the state will be receiving welcome news soon, thanks to a glitch that led to over-collection of taxes and other fees for fiscal year 2010.

Thirty-six homes will receive nearly $1 million in refunds from the state Health Care Financing and Policy Division under a plan the state Board of Examiners recently approved. The overpayments, uncovered during a recent audit, will be refunded in the form of tax credits the facilities can take this year.

In an ironic twist of fate, the refunds actually will result in a net benefit of $700,000 to the state due to new financial rules and regulations, according to the Las Vegas Sun. The state collected $439 million in taxes from nursing homes in fiscal 2010, the newspaper reported.

WEST
Background check fight
WASHINGTON – A law requiring criminal background checks of long-term care employees will stem a disturbing tide of neglect and abuse in the state's nursing homes and other long-term care facilities, advocates say.

Opponents, however, claim that the law's associated $80 million price tag is too costly.

In 2008, voters overwhelmingly approved a referendum requiring federal background checks and increased basic training for people who care for seriously ill seniors and people with disabilities.

The referendum however, was ignored, according to John Lovick, Snohomish County sheriff. Current laws require “limited” background checks for home care workers.

Drug substitutions saved the government $13 million last year, but more drug substitutions under Medicare Part B would have saved an additional $6 million, the Office of Inspector General for Health and Human Services concluded in a recent report to Congress.